The role of allergic and nonallergic rhinitis on success of type 1 cartilage tympanoplasty.

OBJECTIVE: To investigate the role of allergic rhinitis (AR) and non-allergic rhinitis (NAR) on success of type 1 cartilage tympanoplasty. METHODS: This prospective study was conducted on 60 patients who had type 1 cartilage tympanoplasty. The patients were divided into three groups as no-rhinitis (n = 28), NAR (n = 18) and AR (n = 14) groups, based on their symptoms, skin prick tests and/or serum specific IgE levels. AR and NAR groups were treated for their rhinitis symptoms both pre- and postoperatively. The patients were followed up for a minimum of 6 months and compared for graft success rates and audiological outcomes. RESULTS: Three study groups were similar for age, gender distributions and preoperative air-bone gaps (p = 0.780, p = 0.167 and p = 0.676, respectively). Postoperative graft perforation rate was 0% in no-rhinitis and AR groups while it was 16.7% in NAR group, with a significant difference among three groups (p = 0.034). The comparison of three study groups for change in the postoperative air bone gaps in comparison with preoperative air bone gaps did not yield any statistically significant result (p = 0.729). CONCLUSION: Although AR does not result in failure of type 1 cartilage tympanoplasty in patients treated for rhinitis compared to the control group, NAR does. Pre- and postoperative treatment of patients for rhinitis and employment of cartilage graft may be the key factors for success of surgery in patients with AR. Further studies with a larger sample size are needed.

Evaluation of the effects of Covid-19 on cochleovestibular system with audiovestibular tests.

PURPOSE: The purpose of the present study was to investigate the effects of COVID-19 on audiovestibular system with Transiently Evoked Distortion Otoacoustic Emissions (TOAE), Distortion Product Otoacoustic Emissions (DPOAE), video head impulse test (vHIT) and caloric test. METHODS: Audiovestibular findings of 24 patients with moderate/severe COVID-19 and 24 healthy controls were compared using pure tone audiometry, tympanometry, TOAE, DPOAE, caloric test, and vHIT. RESULTS: On audiometry, the pure tone averages of the COVID-19 patients were higher than the controls (P = .038). The TEOAE amplitudes at 4000 and 5000 Hz (P = .006 and P < .01), and DPOAE amplitudes at 3000, 6000, and 8000 Hz (P < .001, P = .003 and P < .001) were significantly lower in COVID-19 patients compared to the controls. On vestibular tests, there was no significant difference between the caloric test results of the patients and the controls (P > .05). On vHIT testing, amplitudes of right semicircular canal was found to be significantly lower in COVID-19 group compared to the control group (P = .008). CONCLUSION: COVID-19 may affect inner ear functions causing a subtle damage in the outer hair cells and lateral semicircular canals. It must be kept in mind that COVID-19 may cause cochleovestibular problems.

The evaluation of the use of isotretinoin on vestibular system by using vHIT.

AIM: The aim of the present study was to evaluate the effect of isotretinoin (ISO) on peripheral vestibular system using vHIT. MATERIAL AND METHOD: This is a prospective study in which 30 patients administered ISO treatment with the diagnosis of acne vulgaris was evaluated. Following ear nose and throat, examination, audiological and vestibular evaluations were carried out. vHIT tests were conducted before and three months after the use of ISO (0.5-0.75 mg/kg/day). In addition, all participants underwent perceptual vertigo and dizziness tests before and three months after the use of ISO. RESULTS: In vHIT evaluation of all patients, no overt saccade, covert saccade and spontaneous nystagmus finding was observed. Gain and asymmetry were compared before and after the use of ISO: No significant difference was found between lateral semicircular canal, anterior, and posterior semi-circular and symmetry measurements made before ISO use and those made three months after it (p = 1.00; p = 0.99; p = 0.66). Similarly, there was no significant difference in asymmetry values of vertical semicircular canals measured before ISO and three months after it (p = 0.90; p = 0.76). No statistically significant difference was found in vertigo, nausea and dizziness in terms of responses before and 3 months after ISO use (p = 0.063; p = 0.031; p = 0.063). CONCLUSION: Although the studies demonstrating the effect of ISO on cochlea and symptoms occurring during treatment such as nausea, vomiting and vertigo suggest that it may exert effects on peripheral vestibular system, the present study indicates that it has no short terms effects on structures in peripheral vestibular system and vestibuloocular reflex pathways.

Effects of a sequential cochlear implant of minimum comfort, impedance and electrically evoked compound action potential values of the initial cochlear implant.

PURPOSE: To evaluate the impact of sequential second CI on the electrophysiological parameters of the initial CI. METHODS: Totally, 30 children who received sequential CIs between January and July 2018 were included in the study. All patients received the same brand of CI (Advanced Bionics, HIRES 90K Advantage 1J). Of 16 CI electrodes, 3rd (E3), 7th (E7) and 11th (E11), and 15th (E15) electrodes which were corresponding to the apical, middle, and basal cochlea were used in the measurements. The tNRI, electrode impedance and M levels were recorded as the contralateral CI was switched off and on, respectively. RESULTS: As the second CI was switched off, the impedance, tNRI and M values of initial CI 1st, 3rd and 6th months were not significantly different (p > 0.05). There was a significant difference between the impedance, tNRI and M values of initial CI as the second CI was switched on (p < 0.05). CONCLUSION: Activation of the sequential second CI leads to a decrease in the tNRI and M levels of the initial CI. This condition can increase the efficiency obtained by CIs. However, these changes should be remembered during CI programming.

Insufficiency of positive airway pressure treatment on increased mean platelet volume: a prospective controlled study in patients with obstructive sleep apnea syndrome.

BACKGROUND: To analyze the association between obstructive sleep apnea syndrome (OSAS) and some hematological variables such as mean platelet volume (MPV), platelet distribution width (PDW), and the impact of positive airway pressure (PAP) treatment on these parameters. METHODS: The participants of the present prospective study consist of 36 OSAS patients diagnosed with polysomnography and recommended PAP treatment and 30 healthy members as the control group. Complete blood analyses were conducted to the patient group twice; before the initiation of the PAP treatment and 1 month after regular PAP use. The control group was administered a complete blood analyses only once. Patient and control group were compared in terms of various parameters such as MPV, PDW, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC) values, and platelet counts. RESULTS: MPV value of the patient group was before and after PAP treatment significantly higher than the control group (respectively; Z = 2.246; p = 0.025, and Z = 2.033; p = 0.042). However, there were no statistically significant differences in the values before and after PAP treatment in the patient group (Z = 0.727; p = 0.467). In terms of platelet numbers and PDW values, no significant differences were determined (p > 0.05). CONCLUSION: MPV value was significantly elevated in OSAS patients. However, the 1 month of PAP treatment was insufficient in decreasing elevated MPV values.

Is resveratrol therapeutic when used to treat allergic rhinitisinitis in rats?

PURPOSE: Resveratrol has anti-infective, anti-inflammatory and antioxidant activities. The purpose of this study was to determine the effect of resveratrol in a rat experimental model of allergic rhinitis (AR). METHODS: Wistar albino rats were divided into three groups: control (n=7), AR with no treatment (AR+NoTr, n=7) and AR with resveratrol treatment (AR+Res, n=7). For AR+Res, AR was induced and resveratrol given on days 21-28. On day 28, the total blood IgE levels were measured. Allergic symptoms (sneezing, nose-rubbing, eye lacrimation and nasal congestion) were scored on a 0-3 point scale, and histopathological changes in the nasal mucosa were evaluated. RESULTS: Allergic symptom score of AR+NoTr was higher than the other two groups and the score of AR+Res was higher than the control group. Histopathologically, neither ciliary loss nor chondrocyte hypertrophy differed among the three groups; however, vascular congestion, inflammatory and plasma cell numbers, eosinophil and mast cell infiltration and goblet cell numbers were higher and mast cell infiltration was more prominent in AR+NoTr than in AR+Res and control. AR+Res and control did not differ significantly in any histological parameter. In AR+NoTr, nasal mucosa exhibited ciliary loss, squamous epithelial metaplasia, inflammatory cell infiltration, vascular congestion of the lamina propria and goblet cell epithelial metaplasia. In AR+Res, goblet cell metaplasia was focal or absent and infiltration of the lamina propria by inflammatory cells, eosinophils, and plasma cells was reduced relative to AR+NoTr. CONCLUSION: Allergic symptoms and tissue reactions were reduced by resveratrol treatment in rats with experimentally-induced AR.

Conchal compression: is it a new syndrome?

OBJECTIVES/HYPOTHESIS: To describe the diagnostic criteria and treatments of concha compression syndrome (CCS). PATIENTS AND METHODS: Patients who reported at least 3 times rhinosinusitis attacks per year were considered in this study. All patients met the diagnosis criteria of rhinosinusitis based on clinical history, showed a nasal septal spur compressing concha on their endoscopic examination and had no findings of rhinosinusitis on their paranasal sinus CT scans but showed concha ondularis. These patients were recognized as suffering from CCS and consequently were surgically treated. RESULTS: 85 patients diagnosed with CCS were included in this study. 25 of the patients were classified as middle, 53 as inferior and 7 as both middle and inferior CCS. Septal spur removal was performed on 16 of the patients whereas the remaining 69 patients received spur removal with septoplasty. After surgery, most of patients' symptoms improved clinically. CONCLUSION: The importance and the necessity of further investigations into this newly-defined syndrome in the differential diagnosis of rhino-neurogenic symptoms is made clear by this study.

[Submucosal lingual schwannoma]. / Dilde submukozal yerlesimli schwannom.

Schwannoma or neurilemmoma is a slow growing, solitary, and encapsulated benign tumor originating from Schwann cells of the peripheral nerves. Lingual schwannomas are rare. A 46-year-old male patient admitted with a complaint of swelling on the right half of the tongue for one year. An approximately 1x1 cm submucosal mass was detected on the right side of the tongue. The submucosal mass was totally excised under local anesthesia. Pathological examination was consistent with schwannoma. Lingual schwannomas should be considered in the differential diagnosis of tongue masses.

Mastoid antral ventilation tube; new treatment modality for reccurent otitis media with effusion and its long term results.

OBJECTIVES: To evaluate the efficiency of mastoid antral ventilation tube (MAVT) treatment in recurrent/chronic otitis media with effusion (OME). METHODS: 20 OME patients who were unsuccessfully treated with ventilation tube (VT) at least twice, who consented to MAVT and who were followed up at least three years were included in the study group. Control group comprised 10 patients who had the same characteristics and refused to undergo MAVT and underwent VT placement again. Pre-operative and post-operative otomicroscopic, hearing tests, and CT findings were compared between the groups statistically. RESULTS: MAVT was placed into 24 ears of 20 patients. In the control group, VT was placed in 13 ears of 10 patients. Postoperatively, in the study group, one tympanic membrane with adhesion and nine membranes with retraction returned to their anatomic positions after MAVT. In the control group, 2 retracted tympanic membranes returned to normal position. There was significant difference between groups in terms of mastoid aeration (P = 0.006). Post-operative pure tone threshold values and mastoid aeration findings were statistically different from preoperative conditions. CONCLUSION: This preliminary study demonstrates that MAVT may be effective in the surgical treatment of recurrent/chronic OME. However, further studies with larger patient series should be carried out.

Lingual Thyroid Excision with Transoral Robotic Surgery.

Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented.

Preparation and placement of cartilage island graft in tympanoplasty.

INTRODUCTION: Cartilage graft tympanoplasty has a better success rate in the treatment of chronic otitis media if regularly prepared and placed. OBJECTIVE: To prepare cartilage island material and evaluate its effect on the success rate of tympanoplasty. METHODS: The medical records of 87 patients (48 males and 39 females; mean age, 27.3±11.2 years; range, 14-43 years) with chronic otitis media without cholesteatoma who underwent intact canal-wall-up tympanoplasty and revision surgery between December of 2007 and October of 2011 were retrospectively evaluated. Surgery was performed under general anesthesia via a retroauricular approach. RESULTS: The overall success rate of this technique was 93% in terms of perforation closure. No graft lateralization or displacement into the middle ear occurred. The overall average preoperative air bone gap was 37.27±12.35 dB, and the postoperative air bone gap was 27.58±9.84 dB. The mean postoperative follow-up period was 15.3 months (range: 7-21 months). CONCLUSION: If cartilage graft is properly prepared and placed, cartilage graft tympanoplasty appears to provide better success rates and hearing results.

Langerhans cell histiocytosis in bilateral mastoid cavity.

A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT) showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH). In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature.

Temporal bone fractures: evaluation of 77 patients and a management algorithm.

BACKGROUND: We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures. METHODS: Seventy-seven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports. RESULTS: Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%). CONCLUSION: In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.

Treatment of Pott's Puffy tumor with balloon sinuplasty: report of three cases.

Pott's Puffy tumor (PPT) is a rare entity characterized by subperiosteal abscess associated with osteomyelitis of the frontal bone. It is usually managed by surgical curettage of the osteomyelitic bone and long-term antibiotic therapy. Balloon catheter dilatation is a new technique which was recently introduced for the treatment of chronic rhinosinusitis. In this article, we present three PPT cases (two of them were secondary to endoscopic sinus surgery) who were successfully treated with balloon catheter dilatation and long-term antibiotherapy.

Papillary thyroid carcinoma with metastasis to the temporooccipital skull: a case report.

The patient was admitted to our clinic with the complaint of swelling in his left post-auricular region. The medical history revealed that he underwent thyroid surgery eight years ago and the specimen was reported as papillary thyroid carcinoma. Following required analyses, total thyroidectomy and biopsy from mastoid region were performed. Total thyroidectomy specimen was proved thyroid papillary microcarcinomas at five foci of the thyroid gland, while biopsy samples obtained from the mastoid region were reported as metastatic papillary thyroid carcinoma. The patient underwent radioactive iodine, followed by radiotherapy. In this article, we present a 61-year-old male patient with papillary thyroid carcinoma metastatic to the temporooccipital region, accompanied by multiple cranial nerve paralysis.

Tympanoplasty with island cartilage or temporalis fascia: a comparative study.

PURPOSE: To compare clinical and audiological outcomes of the type 1 tympanoplasties where conchal cartilage (island graft) and temporalis fascia were used as the graft material. PROCEDURES: In this retrospective study, the results of type 1 tympanoplasty operations (n = 50) in which cartilage and temporalis fascia were used for graft material were compared. RESULTS: Pre- and postoperative otoscopic findings of both groups were similar (p > 0.05). Preoperatively, the pure tone averages (PTAs) and hearing thresholds of the fascia and cartilage groups were similar (p > 0.05). However, postoperatively, the PTAs and air-bone gap closure were better with temporalis fascia compared to cartilage grafting (p < 0.05). On frequency-specific comparisons, the pure tone thresholds at the frequencies of 0.5, 1 and 2 kHz recovered better with temporalis fascia compared to cartilage (p < 0.05). Although the pure tone recovery was better at 4 kHz with temporalis fascia, the difference between the groups were not significantly different (p > 0.05). CONCLUSION AND MESSAGE: In conclusion, in contrast to many reports in the literature, temporalis fascia grafting seems better in our study than grafting with conchal cartilage.

Comparison of outcomes of simple polypectomy plus balloon catheter dilatation versus functional endoscopic sinus surgery in nasal polyposis: a preliminary study.

BACKGROUND: The aim of this study was to compare the outcomes of functional endoscopic sinus surgery (FESS) and simple polypectomy plus balloon catheter dilatation (BCD) in nasal polyposis. METHODS: Ten patients (six male and four female subjects) with nasal polyposis who underwent surgical treatment were included in this research. BCD was performed on one side of each patient's paranasal sinuses (after nasal polypectomy by microdebrider) while standard FESS was performed on the other side. Preoperatively, all patients were treated with oral methylprednisolone, 1 mg/kg per day, for 5 days, which was reduced and stopped on the 14th day. Pre- and postoperative endoscopic and radiological findings were compared. Endonasal endoscopic examination results were classified according to MacKay classification. Paranasal sinus computed tomography findings were evaluated according to Lund-MacKay classification. RESULTS: Pre- and postmedical treatment results of the patients were not significantly different according to MacKay classification. There was no significant difference between the results of FESS and BCD during 12-month follow-up period according to Lund-MacKay and MacKay classifications. There was significant improvement in the results obtained 1 and 12 months after FESS and BCD, respectively. The improvement was also radiologically evident. CONCLUSION: At 1 year postsurgery, polypectomy plus BCD is as effective as FESS. Longer-term studies are necessary to validate this technique.

Shall we resect the tip of manubrium mallei in tympanoplasty?

OBJECTIVES: In tympanoplasty operations if perforation is related with malleus handle, malleus handle is desepithelised. We planned this research to investigate whether the epithelial remnants remain as a result of this desepithelisation or not. METHODS: The 35 patients who were performed tympanoplasty operation were divided into two groups. In the first group which included 13 patients the tip portion of manubrium mallei were cut off without desepithelisation. In the second group which included 22 patients the tip portions of manubrium mallei were cut off after the meticulous desepithelisation. The presence of squamous epithelium was examined histopathologically on the specimens. RESULTS: Squamous epithelium was observed in 9 of the 13 non-desepithelised specimens and in 6 of 22 desepithelised specimens. CONCLUSION: In tympanoplasty operations despite careful desepithelisation, squamous epithelial remnants may remain on the malleus handle. So the tip of manubrium mallei could be resected to prevent the future development of cholesteatoma.

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study.

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis. Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups. The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels. The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.